Million Hearts: Aching at the midpoint?

About midway in its five-year plan, the Million Hearts Initiative may have to pick up the pace if it hopes to achieve its goal for blood pressure control, based on a report released Feb. 14 by the Centers for Disease Control and Prevention (CDC).

Million Hearts was unveiled by the U.S. Department of Health and Human Services in October 2011 as a public-private program designed to prevent a million heart attacks and strokes over a five-year span. The strategy to achieve that goal incorporates four clinical components called the ABCS: aspirin for high-risk patients; blood-pressure control; cholesterol management; and smoking cessation.

The target for blood pressure control is to have control met in 70 percent or more of adults diagnosed with hypertension by 2017. The CDC, which works jointly with the Centers for Medicare and Medicaid Services on Million Hearts, estimates that annually 46,000 deaths would be avoided if 70 percent of adults with hypertension were treated according to guidelines.

In its Morbidity and Mortality Weekly Report, the CDC provided a glimpse into how Million Hearts is progressing. The report focused on health plans that met the target for blood pressure control between 2010 and 2012.

Using the 2010 to 2012 Healthcare Effectiveness Data and Information Set (HEDIS), the CDC and the National Committee for Quality Assurance (NCQA) focused on a performance measure that tracked the proportion of enrollees in a plan diagnosed with hypertension who achieved control. They defined blood pressure control as systolic pressure less than 140 mmHg and diastolic pressure of less than 90 mmHg. They looked at results for the median (50th percentile) and top (90th percentile) performers.

Overall, 64 percent of enrollees with diagnosed hypertension had documented blood pressure control. “Although these findings signal that additional work is needed to meet the 70% target, modest improvements since 2010, coupled with focused efforts, might make it achievable,” the authors wrote.

In 2012, median rates for the blood pressure measure in all plan types and categories fell below the target. Among top performers, only commercial and Medicare HMOs and Medicare PPOs met the target.

Overall, less than 15 percent of Medicare and commercial PPOs and less than 30 percent of commercial and Medicare HMOs met the target. They observed that NCQA-accredited plans were twice as likely to meet the target as were nonaccredited plans and accredited commercial and Medicare Advantage HMOs achieved the highest percentages.

They pointed out that HEDIS does not include data for fee-for-service Medicare members and the blood pressure control performance measure does not capture data on those with hypertension who do not have a documented diagnosis.